Intervention Summary

Coping Cat

Coping Cat is a cognitive behavioral treatment that assists school-age children in (1) recognizing anxious feelings and physical reactions to anxiety; (2) clarifying cognition in anxiety-provoking situations (i.e., unrealistic expectations); (3) developing a plan to help cope with the situation (i.e., determining what coping actions might be effective); and (4) evaluating performance and administering self-reinforcement as appropriate. The intervention uses behavioral training strategies with demonstrated efficacy, such as modeling real-life situations, role-playing, relaxation training, and contingent reinforcement. Throughout the sessions, therapists use social reinforcement to encourage and reward the children, and the children are encouraged to verbally reinforce their own successful coping. Coping Cat consists of 16 sessions. The first eight sessions are training sessions in which each of the basic concepts are introduced individually and then practiced and reinforced. In the second set of eight sessions, the child practices the new skills in both imaginary and real-life situations varying from low stress/low anxiety to high stress/high anxiety, depending on what is appropriate for each child.

The number of sites that have implemented Coping Cat and/or evaluated the implementation of this program is unknown. Approximately 16 outcome studies have been published. Most of the studies have employed versions of the intervention that last approximately 16 sessions. Coping Cat has been implemented in Australia, Canada, the Netherlands, and the United States.

NIH Funding/CER Studies

Partially/fully funded by National Institutes of Health: YesEvaluated in comparative effectiveness research studies: No

Adaptations

Coping Cat program materials have been translated into Chinese, Hebrew, Japanese, Norwegian, Romanian, and Spanish.

Adverse Effects

No adverse effects, concerns, or unintended consequences were identified by the developer.

IOM Prevention Categories

IOM prevention categories are not applicable.

Quality of Research

Review Date: October 2006

Documents Reviewed

The documents below were reviewed for Quality of Research. The research point of
contact can provide information regarding the studies reviewed and the availability
of additional materials, including those from more recent studies that may have been conducted.

Outcomes

Outcome 1: Anxiety diagnoses/disorders

Description of Measures

Anxiety diagnoses/disorders were determined by the Anxiety Disorder Interview Schedule (ADIS), which was administered to both children and parents. The ADIS instruments are structured interview schedules for the diagnosis of anxiety disorders that allow the assessor to screen out other disorders and are consistent with DSM-III-R criteria. The ADIS-IV-Lifetime was used for long-term follow-up because this measure is psychometrically preferable for young adults.

Key Findings

In one study, the number of children receiving the Coping Cat model of CBT who were diagnosed with overanxious disorder or separation anxiety disorder decreased (p < .0001 and p < .01, respectively) from pretreatment to 1 year and 3.5 years posttreatment.

In another study, the anxiety diagnosis was no longer primary for more than 92% of former Coping Cat participants at 7.4 years posttreatment, based on client and parent interviews.

Another evaluation that compared individual and group formats of Coping Cat with a wait-list control condition found that 81% of participants in the individual format no longer met criteria for their primary anxiety disorder at 1-year follow-up. The percentage was slightly lower (77%) for the group format.

Children's self-reported anxiety symptoms were measured using six instruments: (1) Revised Children's Manifest Anxiety Scales (RCMAS), which measures child's chronic anxiety traits including psychosocial symptoms, worry and oversensitivity, and concentration; (2) State-Trait Anxiety Inventory for Children (STAIC), which measures enduring tendencies to experience anxiety and temporal and situational variations in levels of perceived anxiety; (3) Fear Survey Schedule for Children--Revised (FSSC-R), a 3-point scale that assesses specific fears in children; (4) Coping Questionnaire--Child (CQ-C), designed to assess changes in children's perceived ability to manage specific anxiety provoking situations; (5) Children's Negative Affectivity Self-Statement Questionnaire (NASSQ), which are self-statements that children endorse on a scale representing the frequency with which each thought occurred during the past week; and (6) Social Anxiety Scale for Children--Revised (SASC-R), consisting of 22 statements which children rate on a 5-point scale.

Key Findings

Several studies found a significant decrease in child-reported anxiety symptoms in children who received treatment, compared with children in comparison groups (p < .05). The effect was maintained at the long-term follow-up (through 7.4 years). In more than one study, children's coping ability increased significantly from pretreatment to posttreatment (p < .001).

Parent-reported anxiety symptoms in their children were assessed using (1) the Child Behavior Checklist (CBCL) which measures an array of behavioral problems and social competencies, provides scores on several factors or behavior problem areas, and indentifies internalizing and externalizing problems; (2) the State-Trait Anxiety Inventory for Children--Modification of Trait Version for Parents (STAIC-A-Trait-P), with which parents rate the child's trait anxiety; and (3) the Coping Questionnaire--Parent (CQ-P) which assesses parents' perception of the child's ability to manage specific anxiety-provoking situations.

Key Findings

Several studies found a decrease in parent-reported anxiety symptoms (p < .05). Improvements in anxiety symptoms were maintained through 7.4 years posttreatment.

Children were observed performing a task on videotape. Observers used codes to record the occurrence of six anxiety-related behaviors during the videotaped task: (1) gratuitous verbalizations (e.g., stating a physical complaint, dislike for a task); (2) gratuitous body movements (e.g., kicking or shaking leg, rocking body); (3) avoiding task (e.g., leaving the room, not talking); (4) absence of eye contact (e.g., not looking at camera); fingers in mouth (e.g., biting fingernails, touching hand to lips); and (5) trembling voice (e.g., giggling within observational intervals, inaudible speech). The occurrence of each code during 10 30-second intervals was scored and reported as a percentage of the observed units.

Key Findings

Behavioral observations found that participants in Coping Cat model of CBT had reduced anxiety symptoms (e.g., trembling voice, fingers in mouth, absence of eye contact); in contrast, anxiety symptoms increased in the wait-list group. The difference in total observation scores was significant (p < .02).

Quality of Research Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the Quality of Research for an intervention's
reported results using six criteria:

Reliability of measures

Validity of measures

Intervention fidelity

Missing data and attrition

Potential confounding variables

Appropriateness of analysis

For more information about these criteria and the meaning of the ratings, see Quality of Research.

Outcome

Reliability
of Measures

Validity
of Measures

Fidelity

Missing
Data/Attrition

Confounding
Variables

Data
Analysis

Overall
Rating

1: Anxiety diagnoses/disorders

4.0

3.0

3.0

4.0

3.0

4.0

3.5

2: Anxiety symptoms--child report

4.0

3.5

3.5

4.0

3.0

4.0

3.7

3: Anxiety symptoms--parent report

3.5

3.0

3.0

4.0

3.0

4.0

3.4

4: Anxiety symptoms--teacher report

3.0

3.0

3.0

4.0

3.0

4.0

3.3

5: Anxiety symptoms--behavioral observation

4.0

2.0

3.0

4.0

3.0

4.0

3.3

Study Strengths

Reliable instruments were used to measure all outcomes. The use of ADIS-IV-L for outcome 1 (decrease in anxiety diagnosis/disorders) was excellent for long-term follow-up. For outcome 5 (decrease in anxiety symptoms reported from behavioral observations), codes used were adapted from another instrument that appears to have face validity. Additional information was provided about fidelity in each successive study, with the third study having a sound mechanism for assessing fidelity. Attrition was moderate, and appropriate techniques were used to deal with missing data. A rigorous design was used for all studies, minimizing the potential for counfounds. Studies used approriate analytical techniques.

Study Weaknesses

In one study, both individual and group treatments shared the same essential content and procedure; there was no comparison to an alternative treatment condition. All three studies reviewed were limited to the possibility of nonspecific or alternative explanations to positive change. In addition, there are alternative confounds of awareness of condition status and different timelines for pre-/posttreatment versus delayed treatment (wait-list) groups.

Readiness for Dissemination

Review Date: October 2006

Materials Reviewed

The materials below were reviewed for Readiness for Dissemination. The implementation
point of contact can provide information regarding implementation of the intervention
and the availability of additional, updated, or new materials.

Dissemination Strengths

The intervention is described in a fair amount of detail with core components listed in the therapist manual. Implementation materials emphasize a strengths-based approach, and each of the workbooks is written to the developmental level of the target audiences. The therapist manual offers clear descriptions of the processes, rationales, and "tips from the trenches" that could inform training and coaching of new therapists. The therapist manual also describes many therapist processes and behaviors and could serve as a guide for developing fidelity and outcome measures.

Dissemination Weaknesses

No materials are provided for administrators to assess the contextual requirements to successfully implement the program. Images in both workbooks could do a better job of reflecting racial and cultural differences. Though flexibility is emphasized, no guidance is provided in implementation materials to direct adaptation of the materials for diverse clients. More information and strategies could be provided on engaging families as partners in treatment. Therapist selection factors, methods for training therapists to use the intervention, and the nature and content of coaching and clinical supervision are not discussed. Neither therapist fidelity measures nor client outcome measures is provided.

Costs

The cost information below was provided by the developer. Although this cost information
may have been updated by the developer since the time of review, it may not reflect
the current costs or availability of items (including newly developed or discontinued
items). The implementation point of contact can provide current information and
discuss implementation requirements.

Item Description

Cost

Required by Developer

Child's Workbook

$26.95 each

Yes

Therapist's Treatment Manual

$24 each

Yes

Camp Cope-A-Lot: The Coping Cat CD

$20-$2,000 depending on the number of users and subscription package

No

The Coping Cat Video

$49.95 for VHS, $55.95 for DVD

No

The Coping Cat Therapist: Session-by-Session Guide

$79.95 for VHS, $85.95 for DVD

No

CBT4CBT Computer-Based Training To Be a Cognitive-Behavioral Therapist

$95

No

Additional Information

The estimated cost to implement Coping Cat is $45.95 per participant.

Replications

Selected citations are presented below. An asterisk indicates that the document
was reviewed for Quality of Research.

Spence, S. H., Donovan, C., & Brechman-Toussaint, M. (2000). The treatment of childhood social phobia: The effectiveness of a social skills training-based, cognitive-behavioral intervention, with and without parental involvement. Journal of Child Psychology and Psychiatry, 41, 713-726.